Developing a prediction model for cognitive impairment in older adults following critical illness

New or worsening cognitive impairment or dementia is common in older adults following an episode of critical illness, and screening post-discharge is recommended for those at increased risk. There is a need for prediction models of post-ICU cognitive impairment to guide delivery of screening and support resources to those in greatest need. We sought to develop and internally validate a machine learning model for new cognitive impairment or dementia in older adults after critical illness using electronic health record (EHR) data.

Our cohort included patients > 60 years of age admitted to a large academic health system ICU in North Carolina between 2015 and 2021. Patients were included in the cohort if they were admitted to the ICU for ≥ 48 h with ≥ 2 ambulatory visits prior to hospitalization and at least one visit in the post-discharge year. We used a machine learning model, oblique random survival forests (ORSF), to examine the multivariable association of 54 structured data elements available by 3 months after discharge with incident diagnoses of cognitive impairment or dementia over 1-year.

In this cohort of 8,299 adults, 22% died and 4.9% were diagnosed with dementia or cognitive impairment within one year. The ORSF model showed reasonable discrimination (c-statistic = 0.83) and stability with little difference in the model's c-statistic across time.

Machine learning using readily available EHR data can predict new cognitive impairment or dementia at 1-year post-ICU discharge in older adults with acceptable accuracy. Further studies are needed to understand how this tool may impact screening for cognitive impairment in the post-discharge period.